Author Topic: Group Size  (Read 1341 times)

rb2007

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Group Size
« on: April 20, 2016, 12:27:04 PM »
Regarding Mental Health and Substance Abuse, is there a specific number of members that must be attending a group, in order to bill services under group codes?  90853 standard group?
 H0015/0906 Intensive Outpatient Program?

Michele

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Re: Group Size
« Reply #1 on: April 22, 2016, 01:54:09 PM »
I don't see a specific number.  According to the American Psychological Association group sessions are between five and 15 patients.
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tinaraynor

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Re: Group Size
« Reply #2 on: April 22, 2016, 02:35:48 PM »
When I initially read your question, I immediately answered to myself  "more than 2, less than 15, per Medicare". But when I tried to find that in writing I was not able to. But I used that standard when I billed MH services for years.

What I did currently find is several insurance carriers define group size differently, some saying more than 2, less than 10, less than 12, less than 15, etc. It's a good question... and may be best answered by payer of the billed group service.

Ypmb16

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Re: Group Size
« Reply #3 on: July 31, 2016, 09:53:46 AM »
Each insurer has different rules. But it's irrelevant for billing.

PMRNC

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Re: Group Size
« Reply #4 on: August 02, 2016, 09:18:52 AM »
Quote
Each insurer has different rules. But it's irrelevant for billing.

I was going to say same thing.. makes no difference really unless they all have the same insurance plan and that would be freaky !!

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